Rehab Exercise: They Will Do It Wrong

Rule number one in corrective exercise: Patients will do an exercise incorrectly. They will sacrifice quality of movement for quan-tity every time. People who are in pain or recovering from pain have poor motor control and dysfunctional movement patterns. Their nervous system is unable to coordinate movement patterns correctly due to underlying compensation mechanisms. In-office rehabilita-tion exercises must be monitored at all times.

Patients must "own" the movements and exercises before progressing. Simply going through the motions is not an option. When giving your patients home exercises, use the show, teach and do system. Even if you are giving them a handout with pictures and instructions of simple movements, you must always assume they will do it wrong.

The show, teach and do system is as follows: show them the exercise you want them to do by demonstrating it yourself; teach the cueing of movements and actions; and then have them do the exercise in front of you. Only then are they cleared to do the exercise unsupervised.

Does this seem like overkill? Maybe, but I can tell you patients love it when you do this system because it shows them how much you really care. Plus, from a rehabilitation standpoint, any exercise done incorrectly will set a patient up for re-injury.

Policy Procedures

You must have a system in place for office procedures and policies that are customer-service focused. The biggest mistake I see in practice is the complacency of mastering customer service procedures centered on adding value and appreciation.

People don't care how much you know until they know how much you care. This is the golden rule of success in life. Remember what you are there to do: help people! You just happen to use the tool of chiropractic to do it. Here is a list of what I like to call "The Favorite Eight" – eight people-centered actions and procedures that are musts in practice:

1. Call all new patients personally after their first session, and call all existing patients whenever they have a change in their symptoms or exacerbations. Patients love this and are usually dumbstruck that a doctor actually took the time to call!
2. Send a handwritten thank-you note to new patients welcoming them to the office. No e-mails!
3. Send a handwritten thank-you note and a phone call to all patients who refer. Everyone wants to be valued and appreci-ated. Referrals are the lifeblood of a professional service business.
4. Take time to learn about each patient's life and loved ones. Write down important facts in their chart and talk to them about things outside of the office. They are more than just a patient.
5. Address concerns, conflicts or complaints immediately yourself. Do not delegate this to a staff member. The number-one factor that invites a malpractice suit is a feeling of dissatisfaction with regards to service or financial complaints.
6. Have a written policy procedure that you give to each new patient so they understand the process. There should be no sur-prises. Show them each step of the way a detailed road map for getting them to their final destination of feeling better.
7. Use their names often and greet them with positive energy from the first moment they walk in your door. You only have one chance to make a good first impression. Your front-desk staff must be top caliber. Hire for personality first! Personality wins every time. You can teach technical job responsibilities; you can't teach a vibrant personality.
8. Don't be afraid to adapt your program to the individual. There should be no cookie-cutter care program in your office. You are not treating pain. You are treating a person. There are many factors that cause pain and they are not all the same. Listen to what your patients are telling you and adapt your program to their circumstances.

Communication

Reality is all perception. What does that mean? Simply stated, we see the world not as it is, but as we are! We often make the mistake of thinking that everyone knows what we know. In the world of health care this is often called, "The Curse of Knowledge." When we know something, it becomes hard for us to imagine not knowing it. As a result, we become lousy communicators. Our knowledge and experience can render us unable to fathom how little other people know. We are in our own domain of expertise.

Here's the great dichotomy of the Curse of Knowledge: The better we get in our field of expertise, the more unnatural it becomes for us to communicate those ideas clearly. That's why knowledge is a curse. You just need to devote a little time to applying the basic principles of communication so your patients and staff truly understand what you mean. What's the easiest way to ensure someone un-derstood you? That's easy, just ask! When communicating with patients and staff, take time to ensure everyone is on the same page. Use stories and analogies to help communicate complex or detailed topics.

Human imperfection ensures that none of us will ever be free from error. If you do make a mistake, a patient will tend to value your rela-tionship more when you admit error. One of the best things to do with patients if you make a mistake is openly say: "I'm really sorry. I goofed there." Patients are far more forgiving than you can imagine. They not only forgive mistakes if we are open and genuinely apologetic about them; but the admission also helps to humanize the doctor/patient relationship. Always be diligent and work hard to minimize mis-takes. No one is going to be (or should they be) accepting of incompetence!

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